Archive for the ‘State Health Insurance’ Category

You could be one of the millions of Americans getting a refund from your health insurance company soon. The Affordable Care Act has a law called the 80/20 rule, where insurance companies have to spend at least 80% of total premium costs on medical care or improving the quality of health care for consumers. In The Boston Globe’s “Health Insurance Companies Refund $15B to Mass. Consumers,” Chelsea Rice talks about the refunds going out and the companies who will be paying them. The U.S. Department of Health & Human Services released this data showing that Massachusetts consumers will be getting the second highest amount of refunds in the United States. The total refund amount for the U.S. is $332 million, which will pay around $80 a family those those receiving refunds. Florida health insurance companies will be paying the most refunds with $41.5 million owed. Massachusetts residents will be paid out $15 million, which amounts to $133 per family getting a refund.

Almost all of Massachusetts’ residents have health insurance, most through their employer, but 1/4 of them still struggle with the burden of high health insurance costs. The ACA’s 80/20 rule brings transparency and competition to the health insurance marketplace. It also offers greater value to consumers in their health insurance plans. Large group plans have to follow an 80/15 rule. Insurance companies operate more efficiently when they are following this rule by cutting out unnecessary expenses. They have been able to lower premiums throughout the U.S. by $3.8 billion. Companies who do not follow the 80/20 rule during their fiscal year have to refund the excess they spent to consumers in their health insurance plan. Those receiving refunds will get them by August 1 either by check, a discount in next years premium, an account reimbursement or a direct reimbursement through their company.

In Massachusetts, more than 208,000 consumers will be receiving an average refund of $133 per family. This new 80/20 rule has made quite a shift in the amount of upfront value that consumers receive from their health insurance plans. The biggest shift by far has been in the individual health insurance market. Back in 2011, the HHS found that 61% of consumers in the individual market received upfront value from their plans. Just two years later, 81% of people are receiving upfront value from their individual health insurance plans. Ten health insurance companies in Massachusetts will be sending out refunds, including Fallon Community Health Plan, Neighborhood Health Plan Inc. and Tufts Associated HMO. If you are one of the Americans receiving a refund from your health insurance company, look for that in the next week.

Residents of Indiana are getting some new health insurance choices in the state’s health insurance exchange. According to The Courier-Journal’s “Indiana health insurance market to see changes,” Maureen Groppe says that five additional companies will be selling plans in the state exchange this year. There are currently four companies offering plan choices in Indiana. Out of the 16 states that make their information public, Indiana has the most new entrants. There will be some rate changes by the four companies who are already selling in Indiana’s exchange. The highest change is a 96% increase and the lowest change is an 11% decrease in plan costs. More choices mean that Indiana residents who already have health plans could get rates that are significantly lower than their current plan rates.

More than 130,000 Indiana residents purchase health insurance outside of an employer program or Medicare. It’s possible that number could double next year as more uninsured Americans seek health insurance plans through the government exchanges and individual companies to comply with the individual mandate. CareSource is one of the new companies to Indiana’s exchange and plans to offer very low, competitive rates. Their rates are so low in fact, that the state regulators questioned the insurance company’s filing. Premium prices will not be set in stone until just before the November 15 open enrollment period. But the state filings help the market get a feel for what is going to happen in the fall.

Overall health care costs are increasing by 5.4%. Insurance companies have to justify increases in premiums that are much more than the increasing cost for health care. Some insurance companies face a greater amount of claims than others. Indiana is changing the way that their disabled residents qualify for Medicaid, so close to 7,000 people with higher medical expenses will be entering the individual health insurance market next year. Since these Affordable Care Act rules are fairly new, insurance companies are still trying to maneuver this health insurance market where they cannot deny coverage to people with preexisting conditions. Companies are seeking rate increases and also lowering premium costs based on regions in the state and the tier level of different plans. It will take a few years for health insurance companies to determine exactly what premium changes need to be made based on what happens each year with costs and new members.

There is a new partnership in central Florida that hopes to make it easier for Floridians to get health insurance and hospital care. They also want to improve Floridians’ overall healthcare experience. This includes the overall health of the community, the care they receive, and the per person cost of healthcare. According to Yahoo! Finance article, “US News & World Report’s #1 Hospital & NCQA’s #2 Insurance Company, Partner Together to Better Serve the Community,” this partnership has the potential to help a lot of people. It started as a way to bring the new Medicare Advantage plans to central Florida residents. Health First Health Plans was ranked 2nd in Florida by the National Committee for Quality Assurance for their Medicare Advantage Plans. They have consistently received 4.5 out of 5 stars by the Centers for Medicare & Medicaid Services.

Back in January of this year, Health First started working with Florida Hospital to reach a wider range of Floridians seeking Medicare Advantage plans. These particular plans are known as Florida Hospital Care Advantage. Florida Hospital was recently ranked #1 by US News & World Report for Florida hospitals. The partnership between these two organizations should help keep healthcare affordable and local for Florida residents. They are also looking to create sustainable community health systems. It’s important to keep up with healthcare reform changes, especially on a local level. The partnership between Florida Hospital and Health First will expand through different phases, the first of which was the Medicare Advantage plan phase. Although they started in central Florida, they will likely move to other regions of the state as well. If you are looking for more information about Florida health insurance, click here.

There was a time, not very long ago, that you were hard pressed to find health insurance as a pregnant woman. This pre-existing condition was the only reason needed for a health insurance company to deny a pregnant woman’s application for coverage. The Affordable Care Act has changed this former reality, according to “Health law gives pregnant women more options“. In the Associated Press article, it says that Medicaid will help to supplement private insurance plans bought in health insurance exchanges. Pregnant women who recently purchased private health insurance plans through the government exchanges will also be able to access Medicaid coverage from their state as well. This applies to lower-income women, but the income limits vary significantly from state to state. Some state limits are close to the poverty level, while others are more like a middle class income.

Did you know that Medicaid already pays for almost half of the births in the United States? This new expansion of Medicaid services to pregnant women will be effective in every state, even if they have not opted to expand their overall Medicaid system under the Affordable Care Act. Unfortunately the logistics of this Medicaid expansion are fairly complicated. States and the federal government are trying to iron out the details, so it is still complex for consumers to navigate. Overall though, it’s a good thing for women because they will end up paying less out of pocket. They have the option of using only their private health insurance, only Medicaid, or a combination of both plans if that is what will be best for their pregnancy scenario.

While the cost of insuring more women is going to be higher, there are anticipated lower costs overall. Taking care of a woman and her unborn child with good prenatal services helps to avoid the larger expense related to premature births and birth defects. Pregnant women without health insurance often don’t seek prenatal care and can’t be treated for problems that they don’t know exist. The Affordable Care Act made it so that health insurance companies must offer maternity coverage, even if the woman is seeking health insurance while she is already pregnant. For those lower-income women who bought private plans in the health insurance exchanges using federal subsidies, the original law stated that they were no longer eligible for Medicare. Then there was a ruling that said Medicare coverage did not meet the “minimum essential coverage” that the law requires because it is temporary and states can deny certain services. Now they can use their private plan along with Medicaid coverage. A woman might benefit from using both plans because her coverage will continue after she has the baby, but the Medicaid coverage could help with cost-sharing.

There is an interesting development when it comes to your health insurance and your privacy. According to Rhode Island news station WPRI, health insurance companies in Rhode Island are preparing to send your personal health care information to the state. This is happening in twelve other states as well in an effort to better understand health care trends and costs. The goal of this information sharing is to make the entire health care system in Rhode Island, and the other states participating in this program, run more smoothly. All sharing of information is said to be anonymous, so you shouldn’t have to worry about personal consequences related to your health insurance company sharing your health care information with state or federal agencies.

This program in Rhode Island is called the All-Payer Claims Database Project and is a collaboration between multiple agencies. Rhode Island’s Department of Health, Office of the Health Insurance Commissioner, their health benefits exchange and their health and human services department will be sharing health care information and compiling data related to both medical and pharmacy claims. The project assures residents that names, addresses and any other personal information will be removed before the health insurance data is shared. Claims information will be used to help the Rhode Island health care system improve overall. They also seek to improve the quality of health care. Companies started gathering data at the beginning of this year. Starting May 1, companies are now submitting their data to the project.

A representative from the ACLU fears that the information sharing will not be as anonymous as the program promises. He thinks that people would be able to put a name to the indirect information given if they truly wanted to. Sharing your personal health information could hurt you in a job hunt or in other areas as well. But you truly should be safe because the agencies involved assure Rhode Island residents that their information is safe. Keep in mind that you can opt out of having your health insurance claim information shared for this project. You can opt out online through a special website, but there have been complaints that is wasn’t working. Some people worry that those who opt out might actually be targeted though, so that’s something to think about. If the anonymous sharing of your health, dental and pharmacy claims helps improve the overall health care system in your state, would you support it?

Pennsylvania is one of nine states that is giving health insurance customers a break before forcing them to adhere to Affordable Care Act guidelines. According to the Pittsburgh Business Times’ Kris B. Mamula, Highmark health insurance is the latest company offering renewals that don’t meet all of the new insurance mandates. In “Highmark prepares new renewal plan health insurance,” we learn that Highmark is following in the footsteps of UPMC Health Plan with their new renewal options. UPMC was the first company in western Pennsylvania to offer these non-compliant health insurance plan renewals that are lower cost. They started offering these plans four months ago. Highmark Inc. will be offering new renewal plans to employers who provide health insurance coverage. The options will be available during both the July and December enrollment periods.

Plans were introduced during an insurance broker meeting last week. Although minor details were not yet given to the public, Highmark is calling the plans “grandmothered plans”. These lower cost plan options do not meet the requirements of the Affordable Care Act. Insurance companies in Pennsylvania and eight other states have a three-year window where they can continue to offer their existing health insurance plans without penalty. They will have to meet the Affordable Care Act guidelines in 2017, but the added three years gives employers some time to plan out their course of action. More details are expected to be released by Highmark soon.

When UPMC started offering their lower cost plans, premium increases were between 0 and 48%. Plans that incorporate the mandated coverage from the ACA had premium increases 100% and greater. Insurance brokers who were at the recent meeting said that Highmark will be offering more flexibility with their non-compliant health insurance renewal plans. Highmark is also likely to see a large increase in sales of their Community Blue plans, which limit the network of providers available. It’s good news to employers and others who will benefit from the three year reprieve given in Pennsylvania and eight other states. But eventually they will all have to meet the new guidelines put into place by the Affordable Care Act. They will save money and have added time to determine their best plan options starting in 2017. But in other states, health insurance companies will already be settled into their new health plans and insurers in these nine states will have to play catch up.

The deadline to sign up for health insurance and meet the Affordable Care Act requirements has come and gone. Health insurance exchanges will not start offering plans until later this year for the next enrollment period. But most people were not expecting some private health insurance companies to stop selling health insurance plans after March 31 as well. According to Health Day’s Karen Pallarito, “Suddenly Health Insurance Is Not For Sale“. One Tennessee insurance broker said that many health insurance companies in her area are not selling insurance plans until the exchanges open again later this year. One of the main reasons that some health insurers have made this decision is because they believe they will attract healthier, younger people when the government exchanges are open as well. Insurance companies can no longer reject sick people or those recently diagnosed with a disease. They are hoping that they will be able to attract the young, healthy individuals that will keep their costs lower.

For coverage that will start in 2015, the next open enrollment period starts on November 15. Penalties for not obtaining insurance coverage yet won’t be issued until tax time next year, but those who waited might just be ready to purchase insurance come November. Healthy and young individuals are most likely to plan in advance when shopping for health insurance. That is why it makes sense economically for health insurance companies to only offer plans during open enrollment times. Individuals who have recently become sick or need some type of care right away are the most likely to search for health insurance at any time of the year. Open enrollment periods were designed to deter people from waiting until they are sick to shop for health insurance. When that happens, insurance can become unaffordable all around.

Health insurance companies offering plans outside of the exchanges can choose whether or not to sell health insurance year round or not. One survey of 180 health insurance companies found that one or more health insurers will be offering plans after March 15 in only 14 states. Some of those plans will only be offered through the end of April. You will be able to find health insurance in some places though. Arizona’s non-profit insurer Meritus plans to continue offering health insurance plans year round. They are currently working with the Arizona Department of Insurance. In Nevada, their Health Coop will continue offering insurance plans to consumers around Las Vegas. There may be some states where it is difficult to find health insurance before November 15. If you are looking for a plan, you will probably have to work a little harder than before the deadline.

The country has been very focused on uninsured Americans over the past couple of years. Another important issue that is rarely discussed is how many people are actually underinsured. U.S. News & World Report’s Kimberly Leonard discussed research from the Commonwealth Fund in her article, “Report Highlights Underinsured by State”. The Commonwealth Fund’s report is called “America’s Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions”. When looking at Americans under the age of 65, one out of every eight is underinsured. This means that although they do have health insurance, they still pay a high percentage out of pocket for health care costs. Many underinsured Americans end up filing for bankruptcy because of their health care bills. They are also at a high risk of ignoring symptoms and avoiding the doctor.

States with the lowest rates of underinsured Americans were in the Northeast and the upper Midwest. The Southern and Western states had the highest rates. New Hampshire’s underinsured rate of 8% was the lowest in the nation. Some of the other states with low rates include Minnesota, Maryland, and Massachusetts. The highest underinsured rate of 17% belongs to both Idaho and Utah. Both Tennessee and Mississippi had underinsured rates of 16%. When the report looked at the combination of uninsured and underinsured Americans, the highest numbers of uninsured and underinsured Americans were in New Mexico and Texas. Middle income Americans in Wyoming and Alaska suffer the most from being uninsured or underinsured. One-third of the middle income population in those states falls into the uninsured or underinsured category. The lowest uninsured and underinsured rates were in Connecticut, Massachusetts, Minnesota, and the District of Columbia. These states had combined rates less than 20%.

Deductibles, premiums, household income, and insurance status were taken into account for the report results. Lower income households, earning less than $47,000 per year for a family of four, are considered underinsured if they spend more than 5% of their yearly income on health care costs. Middle income households, earning between $47,000 and $95,000 per year, are underinsured if more than 10% of their annual income is spent on health care. The Commonwealth Fund report found that $32 million Americans are underinsured, $4 million of whom come from middle income families. It also showed that 47 million Americans were uninsured in 2012. Obviously this data was collected before the Affordable Care Act went into effect. It will be a good comparison for the next few years to see if the ACA makes the changes that it set out to make in “fixing” our health care system. The number of uninsured Americans has certainly gone down, and the number of underinsured Americans should as well. Since insurance companies can no longer discriminate against those with preexisting conditions and they must offer affordable plan choices, fewer Americans may be underinsured in the future.

While we are the United States of America, we are made up of a wealth of different cultures and backgrounds. Some health insurance marketing fails to take that fact into account. In “Selling Health Care To California’s Latinos Got Lost In Translation,” NPR Station WCAI discusses the nuances with the Latino culture and health care. The article specifically looks at California because 30% of the state speaks Spanish. Unfortunately for many advertisers and health insurance companies, simply translating an English slogan or commercial to Spanish does not work. Covered California, the state insurance exchange, started advertising benefits of the new health insurance laws that don’t actually appeal to many Hispanics. Advertising the importance of not being denied coverage for pre-existing conditions is great for most Americans. Many people have been denied individual health insurance or know someone who has. But this article says that the majority of Hispanics in California not only have never even been insured, they also haven’t even shopped around for health insurance because they didn’t consider it. Having health insurance isn’t typically a norm in their culture.

Another problem with the Covered California Spanish advertising is that the commercials end by listing a website to visit, but no phone number or address. Latinos are all over the internet, but research has shown that they don’t prefer to do transactions online. They would rather speak to someone on the phone or in person. This especially holds true for purchasing health insurance because it can be complex, confusing, and many of them have never had health insurance before. Officials say that they have been working on offering more locations for Latinos, as well as other residents, to be able to physically go somewhere and speak with someone about their health insurance options.

The Covered California name itself doesn’t really translate to something exciting and the ads have been perceived as “dry”, exactly the opposite of the Latino culture. It’s seems simple as an outsider to see that you need to market your insurance plans differently to different cultures. And in California, when 30% of the population is Spanish speaking, you have to account for that and the differences in the Latino culture. It matters to the general population if Latinos sign up for health insurance coverage. Why? Latinos are younger and healthier, on average, so when they are in health insurance pools overall premium costs are lower for everyone else. Only 6% of those who have signed up for the new California health insurance speak Spanish as their first language. While the March 31 deadline for coverage sign-ups is fast approaching, an overall improvement in marketing strategy will help Latinos and the health care industry as a whole.

There is good news for people with individual and small group health insurance plans Illinois. Many of the more than 185,000 people who received cancellation notices from their insurance company will have a year long reprieve from finding new coverage. After an outcry from Americans, President Obama has urged state insurance regulators to make exceptions to the Affordable Care Act requirements. Many existing health insurance plans do not meet all of the requirements, causing hundreds of thousands of people to get a cancellation notice. If your insurance plan was effective prior to October 1 of this year, you will now have until October 1 of 2014 to select a new insurance plan. This is great news to Americans who were scrambling to make health care plan decisions by January 1. WGN’s Peter Frost discussed the details for Illinois residents in the story “Illinois to let companies sell existing health insurance plans.”

Blue Cross and Blue Shield of Illinois, the largest insurance company in the state, said that they will be contacting people who received cancellation notices to tell them their new options. More than 475,000 people in Illinois had individual health insurance policies as of data collected in 2012. Some of the people whose plans do not meet Affordable Care Act requirements will receive federal tax credits to help pay for new insurance plans. But many others are upset because their new plan options cost double what their prior health insurance plans cost. So far, 15 states have told their insurers that it’s okay to extend current insurance plans for another year. Some states are not allowing this plan extension though, despite the President’s request for them to do so. Some insurance companies worry that extending old plans will keep too many people out of the health insurance exchanges, which could raise those plan costs. Those people who are buying plans in the health insurance exchanges have until December 23 of this year to purchase a plan that will go into effect January 1.